Hypertension (especially isolated systolic) is the most common chronic condition in older adults and is a major risk factor for both cardiovascular and cerebrovascular diseases. Previous randomized controlled studies have shown that blood pressure treatment in older adults (65+) can be effective and reduce hypertension-related complications. However there is uncertainty regarding the generalizability of these beneficial findings to frail community dwelling older adults 85+ years of age and the potential risks that the sometimes necessary use of multiple anti-hypertensives (i.e., polypharmacy) to control blood pressure may have. Indeed, the use of multiple anti-hypertensives in older adults has been linked to increased risk of mobility problems and cognitive impairment. The long term objective of the proposed research is to enhance the health of the elderly by determining the magnitude of the benefits and risks of antihypertensive use so that future prescribing guidelines can be more evidence based and less dependent on expert opinion. Using a longitudinal design, the immediate objective is to determine the potential benefits and risks of antihypertensive use in community dwelling older adults with hypertension over a five year follow up. Anti-hypertensives will be operationally defined as medications from the following eight classes: 1) beta blockers; 2) peripheral alpha blockers; 3) calcium channel blockers; 4) angiotensin converting enzyme inhibitors; 5) angiotensin receptor blockers; 6) direct vasodilators; 7) diuretics and 8) central alpha blockers. In AIM 1, we will examine potential benefits by determining the association between antihypertensive use (as defined by four alternative approaches above) and blood pressure control (defined as d 140/90 mmHg) and hypertension-related complications (i.e., adjudicated hospitalization or death due to cardiovascular and cerebrovascular diseases). The Aim 1 specific hypotheses to be tested among those with hypertension are that, compared with non exposed elders, participants with antihypertensive use will be more likely to have blood pressure control and less likely to have hypertension-related complications after propensity score matching and adjusting for important covariates in multivariable analyses. In Aim 2, we will examine potential risks by determining the association between antihypertensive use (as defined by four alternative approaches above) and mobility problems (Short Physical Performance Battery [SPPB], and gait speed), and cognitive function decline (as measured by the Modified Mini-Mental State Examination [3MS] and the CLOX 1 Test). Aim 2 specific hypotheses to be tested among those with hypertension are that, compared with non exposed elders, participants with antihypertensive use (as defined by four alternative approaches detailed below) will have worse performance on the 3MS, CLOX1, the SPPB, and usual walking pace over six meters after propensity score matching and adjusting for important covariates (e.g., blood pressure) in multivariable analyses. PUBLIC HEALTH RELEVANCE: The current proposal builds on our previous and successful NIA funded grants (R01 and R56) that examined CNS medications and specific self-reported geriatric syndromes using the rich and pre-existing NIA funded Health ABC study database. Funding of this proposal will allow us to extend our work to anti-hypertensives and examine important measured geriatric outcomes (i.e., functional status and cognition), physiologic measures (i.e., blood pressure control), and morbidity and mortality (i.e., hospitalization and death due to cardiovascular and cerebrovascular disease). Such studies are consistent with NIA's priority comparative effectiveness research area.